RHEUMATIC FEVER
The elimination of rheumatic fever as a public health problem in Grenada
Goal
The aim of this project is to eliminate Rheumatic Fever (RF) as a public health problem in Grenada. Achievement of this goal will reduce the long-term morbidity and mortality from RF. It will also save many millions of dollars that have been spent over the last 18 years on costly surgical repair of damaged heart valves.
Project Collaboration
This is a collaborative project between WINDREF and Rockefeller University, the University of Minnesota, the Grenada Ministry of Health and the Ministry of Education and the Grenada Heart Foundation.
Project Location
Grenada, West Indies
Time Frame
The elimination program started in November 2000 and should run through 2004.
Project Background
RF has been all but eliminated from the developed world but in developing countries it still poses a serious threat to the health of children with long term morbidity and mortality consequences. RF is a good example of an easily preventable condition at low cost with good long term health outcomes.
RF is a nonsuppurative, immune mediated disease affecting principally children between 5–15 years of age. RF generally follows an infection, usually pharyngeal in origin, by group A Beta-hemolytic streptococci. The potential sequelae can be extremely disruptive and detrimental to the quality of everyday life.
It is believed that M proteins, present on the surface of specific strains of rheumatogenic streptococci, evoke antibodies that, in conjunction with other immune mechanisms, elicit an acute disease that is systemic in nature and is characterized by polyarthritis, skin lesions, and carditis. The arthritis and skin lesions resolve, however, the cardiac involvement can lead, decades later, to permanent valvular deformity (usually scarring of the mitral valve). The accepted treatment for RF is penicillin, or erythromycin for those patients allergic to penicillin.
This project has enjoyed great progress since its inception. An extensive educational program was undertaken which is set to continue through 2002. The aim of the educational project comprises the use of the media in the form of radio and television spots used in conjunction with educational posters and pamphlets distributed throughout the Tri-island State.
In April of 2001 a clinic was established for existing and incident cases of RF. The free, monthly clinic is run by Dr Beverly Nelson and our newest addition to the project, Nurse Geraldina Perrotte. The project is also involved in community Health Fairs. Educational billboards will be set up across the Tri-island State of Grenada.
A retroactive study examining the incidence of RF in Grenadian children 5-15 years of age was completed (See Figure).
 |
1989-92 | 1993-96 | 1997-00 |
| St Andrews | 0.26 | 0.11 | 0.21 |
| St. Davids | 0.22 | 0.11 | 0.11 |
| St. Georges | 0.18 | 0.21 | 0.12 |
| St. Johns | 0.37 | 0.09 | 0.23 |
| St. Marks | 0.49 | 0.39 | 0.39 |
| St. Patricks | 0.34 | 0.15 | 0.19 |
| Carriacou | 0.14 | 0 | 0 |
| Mean | 0.253 | 0.149 | 0.166 |
This data enables us to identify the potential hotspots or outbreak areas which, in turn, allows us to focus our educational and treatment efforts in the appropriate areas. In addition to this retrospective study in order to estimate the true current prevalence of streptococcal infections in Grenadian schoolchildren over 1,200 samples have been obtained from children attending 37 of Grenada’s schools. Samples are sent to Rockefeller University for further analysis and sub-grouping. Initial results show that the prevalence is approximately 1.3%.
Funding
We would like to thank the donors of the RF project who include the Lounsebury Foundation, the Grenada Bank of Commerce (RBTT), Cable and Wireless (Grenada) and the Florida Caribbean Cruise Association (FCCA). Pediatric clinics are provided free of charge by Dr Beverly Nelson.
